Machinify offers AI-powered healthcare payment integrity solutions to enhance claims accuracy, recovery performance, and cost control. Backed by Battery and GV.
About the role
Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a claims editing content expert to help build the next generation of editing content and make healthcare payments more accurate and affordable. This role will bring deep expertise in New York State Medicaid. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- 7+ years of experience in claims editing, clinical coding, Payment Integrity, or payer policy, with hands-on experience authoring or validating edits
- Active coding credential, such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license (such as RN) paired with deep coding experience
- Deep, current knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, coding guidelines, and documentation requirements
- Working knowledge of reimbursement methodologies, including fee schedules, DRGs, APCs, and professional and facility billing
- Experience sourcing and interpreting primary content, including CMS manuals, NCDs and LCDs, AMA guidance, and payer policies
- Strong analytical skills and comfort working with claims data, using SQL, Excel, or similar tools to test hypotheses and measure results
More about this role
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a claims editing content expert to help build the next generation of editing content and make healthcare payments more accurate and affordable. This role will bring deep expertise in New York State Medicaid.
As Content Innovation, Claims Editing - NY Medicaid you will source, design, validate, and maintain the clinical and coding content that powers our editing products. You will find opportunities in policy and in the data, turn them into edits that hold up,...
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